Question: November 19 is international No Smoking Day. Has any progress been made over the past twelve months with regard to the no-smoking policy? What’s new in this area?

Answer: We have been implementing the WHO Framework Convention on Tobacco Control. Also, in Russia, there has been an important shift in the public discussion of smoking, as officials as well as the general public wish to know more about tobacco producers: who they are, what they want and what goals they have.

Russia’s Public Chamber has published a report that emphasized the need to monitor tobacco producers, insisting on their transparent operation and on tobacco industry denormalization.

This is an important shift from the earlier focus on smoking as a social phenomenon without considering the manufacturer’s role in the tobacco epidemic.

Smoking’s hazards to human health have been in the public focus since the 1970s. Later smoking was highlighted as a major risk factor, then it was tied to demographic problems. The idea of blaming the producers as those who make huge profits on smoking emerged only recently – Russians have now realized that the only side benefiting from smoking is the foreign tobacco industry, as 95% of tobacco production in Russia is controlled by foreign companies.Q: But why is this so? What are the reasons?

A: The reason is that foreign tobacco companies have strategically taken advantage of two major crises in modern Russian history – the collapse of the Soviet Union and the 1998 default. They reinforced their positions in Russia during those periods. More than half (66%) of the foreign investment in Russia’s tobacco industry went to St. Petersburg, the Leningrad Region and Moscow. These three areas account for 80% of the profits from tobacco sales.

Q: Can you cite any statistics on how many smokers there are in Russia? Is their number growing or decreasing?

A: About smoking in Russia, I can give you the following figures. According to various reliable estimates, smoking is seriously affecting the demographic situation in Russia: 350,000-400,000 people die annually from smoking related disorders. According to WHO data, 72% of men are smokers, 30% of women, and 50% of children and teenagers. This year, a small downward trend is possible. But this does not mean that the problem has been resolved or that our efforts have been successful.

I would say the Public Chamber’s new focus on the impact of smoking on the country’s demographics is a positive step.

Q: Why is the number of smokers decreasing in other countries, and more people support a healthy lifestyle?

A: This is directly linked to the resistance put up by tobacco producers, who lobby their own interests. In Russia, for example, tobacco excise taxes are one-seventeenth of European or American rates. This is why our country is seen as a threat to many adjacent countries, because of cheap cigarette smuggling.

Another reason is advertising. Foreign companies spend $1 billion a year to advertise their products in Russia, while the social advertising budget is only $20 million. These figures are not comparable.

Q: Can you suggest a solution?

A: I think the only policy which could check tobacco industry growth is Russia is nationalizing the industry. It should also be subject to tight public supervision. The excise tax should be raised and tobacco advertising restricted.

Another useful policy would be to discredit the tobacco business as a career. As of today, many young people consider employment in this industry a good career opportunity. Salaries at tobacco companies are high – for example, a PR vice president at a large company can make 500,000 rubles ($17,500) a month.

In fact, many government officials are aware of the problem. But tobacco companies scare them with social unrest if people cannot buy their cigarettes.

Personally, I think the best idea is to nationalize the industry, and put it under the Healthcare Ministry’s control, the way it is done in Finland. As long as tobacco producers call the tune, we cannot do much to remedy the situation.

November 20, 2009 - MIAMI -- A South Florida jury on Thursday, November 19th ordered Philip Morris USA to pay $300 million to a former smoker, agreeing that the tobacco company's negligence was the cause of her emphysema.

"Cindy admitted her fault to the jury," her attorney, Robert W. Kelley, said in a statement. "But Philip Morris refused to accept any responsibility for her emphysema, even though she was an addicted customer for 25 years."

The award amounts to $56 million in compensatory and $244 million in punitive damages against Richmond, Virginia-based Philip Morris USA, a unit of Altria Group Inc. The company said it will seek further review of the verdict by the Broward County jury.

"From the beginning, this case was marked by a fundamentally unfair and unconstitutional trial plan that allowed the jury to rely on findings by a prior jury that have no connection to the plaintiff," said Murray Garnick, senior vice president for Altria client services and associate general counsel, said in a statement.

Attorneys for Naugle, the sister of a former Fort Lauderdale mayor, said it's the largest Florida tobacco verdict to date.

"The jury saw her condition," Todd Falzone, who also represented Naugle, said in a statement. "We think that they felt it. She needed to rest for five minutes to catch her breath after making the 7 step walk to the witness stand."

Naugle started smoking in 1968 when she was 20 because she thought they "made her look older." After several attempts to quit, she stopped smoking in 1993 with the aid of a nicotine patch. She requires 24-hour oxygen and must travel in a wheelchair because walking leaves her exhausted, her attorneys said. Falzone said Naugle spends every minute "as if she were drowning."

The smokers' lawsuits have been working their way through Florida courts since the state Supreme Court in 2006 voided a $145 billion class-action jury award against tobacco companies. The court said each smoker's case had to be decided individually, but let stand that jury's findings that tobacco companies knowingly sold dangerous products and hid risks from the public.

"Large verdicts encourage other large verdicts," said Richard A. Daynard, professor of law at Northeastern University and chairman of the Tobacco Products Liability Project. "I think Philip Morris has finally met its match in Florida. This gives jurors permission to fully compensate plaintiffs for all the harm they suffered and to express their moral outrage at the industry's behavior."

November 20, 2009 - More than 70 percent of smokers in Bulgaria wanted to give up smoking, Yulia Medichkova of the Greenwild Foundation was quoted by Bulgarian news agency (BTA) as saying on November 19 2009.

Medichkova presented the results of a one-year campaign entitled The Culture of Breathing. Over 50 percent of Bulgarians approved of increased restrictions on smoking that will be introduced by mid-2010. Bulgaria ranks third in the world in terms of number of smokers, after Japan and Greece, Medichkova said.

What was more worrying, according to another survey released by the Health Ministry on November 17 2009, was that every second pregnant woman in Bulgaria smoked during pregnancy. Smoking during pregnancy was considered extremely damaging to unborn babies' health, as the baby risks being born with a lower weight and higher risk of disease.

According to the survey, 52.4 per cent of men in Bulgaria smoked, compared to 38.1 per cent of women.

“The New York metropolitan area continues to be a lucrative market for counterfeit and contraband cigarette smugglers,” said Joe Murillo, vice president and associate general counsel, Altria Client Services, speaking on behalf of PM USA. “High excise taxes, coupled with New York state’s lack of effective tax enforcement, only makes the problem worse,” added Murillo.

“The sale of untaxed cigarettes harms legitimate wholesale and retail businesses and costs New York and New Jersey needed tax revenues that could be used to support essential public services,” added Murillo.

“Currently, the New York legislature is debating solutions to address the state’s current fiscal crisis, including the enforcement of existing cigarette tax laws,” Murillo explained. “Estimates vary, but New York could be collecting hundreds of millions of tax dollars on cigarettes sold to non-tribal members through Native American reservation outlets. Effective tax collection could also help stabilize the legitimate cigarette distribution channel in New York, which is increasingly under attack from counterfeit and contraband cigarette smuggling,” said Murillo.

The announcement by the Society's government relations director Jennifer Stally came on the 34th annual American Cancer Society Great American Smoke Out Day. Stalley said in a news release that the Cancer Society "will begin in earnest our statewide effort to support the smoke free law on the November 2010 ballot and ensure that no one has to choose between their health and their job in our great state."

Circut Court Judge Kathleen Trandahl ruled on Nov. 13 that opponents of the ban had collected enough signatures to put the issue on the 2010 ballot. Trandahl found that opponents of the ban had collected 2,244 more signatures than they needed to force a public vote.

Bar and casino owners collected the signatures calling for a public vote. After the American Cancer Society challenged some of the signatures, Secretary of State Chris Nelson ruled that many of the signatures were invalid. See related news briefs below.. Ban backers then appealed Nelson's ruling, sending the matter to circuit court.

November 20, 2009 - The University of Auckland will become the country's first smoke-free university next year. (This university is the largest and has the most comprehensive range of courses offered in New Zealand.)

From January 1, 2010 smoking will be banned on all Auckland University campuses and outdoor spaces, including places previously designated as smoking areas. In a revision of its smoke-free policy, the university decided the old policy was not combating risks to non-smokers from passive smoking.Staff and students were asked for their views on three options - maintaining the status quo, banning smoking within 10m of buildings and facilities or total prohibition. Seventy-five per cent of those who responded supported total prohibition, 13 per cent favoured the status quo and 11 per cent wanted a 10m rule.

About 5000 people a year die in New Zealand from smoking-related illnesse - population as 2008 - 4,268,600.

The new policy aims to eliminate the effects of passive smoking and create a healthier and cleaner environment for staff and students.

Auckland University Student Association vice-president Joe McCrory said the association voted two out of three in favour of the ban. He said the reaction from students has been mixed. Those on medical campuses were largely in favour of the change, but student smokers were not happy at being forced on to the street to indulge. The ban will also affect students living in university accommodation as these areas will become smoke-free. Also included in the ban are the outdoor areas of student cafes and bars.

Mr McCrory said news of the ban had been placed on the student website Cecil and there would be a campaign directed at new students during next year's orientation period.

Action on Smoking and Health (ASH) smoke-free health promotion team leader Grant Hocking said the university had a real problem with smoke getting into lecture theatres through the air conditioning systems. Hocking: the ban was fantastic. "Life-long learning should be smoke-free."

See companion news brief: U.S. - Senate Committee scheduled to vote on PACT..The Prevent All Cigarette Trafficking (PACT) Act closes gaps in current federal laws regulating “remote” or “delivery” sales of cigarettes and smokeless tobacco products. The bill enhances penalties for violations and provides law enforcement with new tools to combat the innovative methods being used by cigarette traffickers to distribute their products.

“Tobacco smuggling has developed into a popular, and highly profitable, means of generating revenue for criminal and terrorist organizations,” said Sen. Herb Kohl (D-WI), noting that cigarette trafficking, including the illegal sale of tobacco products over the Internet, costs states billions of dollars in lost tax revenue each year.

“More people are selling cigarettes illegally, and they are getting better at it. As these cases become more difficult to crack, we owe it to law enforcement officials to do our part to lend a helping hand,” Kohl said.

The PACT Act will:

* Strengthen the reporting requirements for interstate cigarette sellers. * Increase the criminal penalty from a misdemeanor to a felony and create a substantial civil penalty for violations, including violations of the reporting requirements and state tobacco tax laws. * Grant federal and state law enforcement officials more powers to investigate and prosecute violators. * Prohibit the United States Postal Service from delivering tobacco products

On May 21, 2009, the House of Representatives passed companion legislation by an overwhelming majority of 397 to 11, and the Senate Judiciary Committee unanimously approved Kohl’s PACT Act in May 2007.

NACS, as part of the Coalition to Stop Contraband Tobacco, urged Senate passage of the PACT Act this week on Capitol Hill.

“At the very time when states have undertaken extraordinary efforts to restrict minors’ access to cigarettes and continue to increase cigarette excise taxes, the Internet still offers minors a virtually risk-free and attractively priced means to easily obtain them,” said Hank Armour, NACS president and CEO. “The PACT Act addresses long-standing concerns that law-abiding neighborhood convenience stores have with respect to tax evasion and underage sales.”

November 19, 2009 - The Center for Tobacco Products has scheduled a web-based training session on use of the eSubmitter program to electronically submit establishment registration and product listing information (see here). Submission of that information by December 31 is required under FDCA section 905. Those who are interested in participating are directed to provide their Company name and contact information to eSubmitter@fda.hhs.gov by noon on Wednesday, November 18. FDA advises that, in the absence of sufficient interest, the training may be cancelled.

November 19, 2009 - PACT (Prevent All Cigarette Trafficking (PACT) Act.. The illegal sale of tobacco products through the Internet leads to tax evasion and tobacco use by young people, members of Congress and merchants said Tuesday, November 17th. The Coalition to Stop Contraband Tobacco urged the Senate to pass a bill that would address the issue. The bill is scheduled for a vote Thursday, November 19th by the Senate Judiciary Committee.

PASS THIS LAW.. - In the U.S. Senator Herb Kohl is sponsoring a bill which would clamp down on illegal tobacco sales. H.R. 1676, the Prevent All Cigarette Trafficking Act (the PACT Act) of 2009, was passed 397-11 by the House of Representatives on Thursday, 5/21/2009. This legislation is extremely important, it will effectively end Internet and telephone tobacco smuggling by stopping shipments of cigarettes and smokeless tobacco through the U.S. Postal Service. FedEx, UPS, and DHL have already agreed not to mail tobacco. (Let's Get It Passed - Prevent All Tobacco Trafficking Act of 2009..)

"Each day we delay its passage, terrorists and criminals raise more money, states lose significant amounts of tax revenue, and kids have easy access to tobacco products sold over the Internet," said Sen. Herb Kohl, D-Wis., who sponsored the Prevent All Cigarette Trafficking (PACT) Act.The PACT Act, which would amend the 1949 Jenkins Act, increases penalties for violations, requires shipping records to ensure that taxes are paid and requires sellers to obtain age and identification verification from buyers. The Jenkins Act required sellers who ship tobacco products to report sales to state or local tobacco tax administrators.

All of the speakers said that tobacco products sold at online discount stores do not include state taxes, which eliminates competition with legal products that include the sometimes hefty taxes. According to the Justice Department, $5 billion of tax revenue is lost at the local, state and federal level every year.

Kohl said international criminal and terrorist organizations profit from the smuggling and sale of counterfeit cigarettes. The money is raised in the U.S. and funneled back to the groups, he said.

Jon Burkland, incoming chairman of the American Wholesale Marketers Association, said that the illegal sale of tobacco products hurts those who sell them legally. "From the distributor perspective, every illegal sale made on the Internet translates into a loss of a legal sale made by a law-abiding retailer or distributor," Burkland said. "It levels the playing field for hard-working, family-owned businesses by ensuring that everyone pays the proper taxes."

In New York, where the cigarette tax is $2.75 a pack, hundreds of thousands of smokers regularly buy cigarettes on the black market or online, said James Calvin, president of the New York Association of Convenience Stores. He said people turn to illegal means of buying cigarettes because of the steady increase of the state's cigarette tax. "So pervasive is this problem, that today, more than half of the cigarettes consumed by New Yorkers are purchased without the payment of any state or local tax whatsoever," Calvin said. "It cripples tax-collecting stores by depriving us of legitimate sales."

The wholesalers group conducted a study in 2005 to see if people could purchase cigarettes online and pay the state the taxes they owed. Despite a 2005 agreement among the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives, state attorneys general and major credit card companies to ban all transactions with Internet cigarette vendors, the association found it was easy to buy cigarettes without taxes and required little or no age verification. They said it was difficult to figure out how to pay the taxes. When the group conducted a follow-up study in 2009, it found that little had changed.

"My 16-year old daughter has a debit card, I'm lucky that she doesn't smoke, but she can go online and buy these kinds of things," said Ronald Hampton, executive director of the National Black Police Association. Hampton, who is retired from the Washington's Metropolitan Police Department, said he has seen an increase in young people smoking cigarettes. He said the PACT Act would make it easier for law enforcement to combat contraband tobacco.

Matthew Myers, president of the Campaign for Tobacco Free Kids, said illegal Internet sales of tobacco leads to an increase in the number of people who die from tobacco use. "It is a farce, It's a joke to think that the current requirements are capable of cutting off tobacco sales," he said.

November 19, 2009 - KUALA LUMPUR, The ban on cigarette sponsorship for sports activities, especially football, will not be withdrawn by the government, deputy minister of Youth and Sports Datuk Razali Ibrahim told the Dewan Rakyat Thursday, November 19th. (Dewan Rakyat or House of Representatives is the lower house of the Parliament of Malaysia. All bills must usually be passed by both the Dewan Rakyat and the Dewan Negara (the Senate), before they are given Royal Assent by the Yang di-Pertuan Agong (Monarch). Members of the Dewan Rakyat are often referred to as Members of Parliament or MPs. Like the Dewan Negara, the Dewan Rakyat meets at the Malaysian Houses of Parliament in Kuala Lumpur (Dewan Rakyat).

Razali said there will be no change in the government's commitment to support the World Health Organisation's (WHO) global ban on cigarette companies sponsoring any kind of sports activities under the Framework Convention on Tobacco Control (FCTC).

He said Malaysia had signed the FCTC agreement on September 23, 2003 and became a member on September 16, 2005 and in line with the FCTC requirement, introduced a ruling to enforce laws under Regulations of Tobacco Products, effective August 14, 2004.

"However, an exception was given to football (till end 2004) and for motorsports (till 2006) to enable the sports to fulfill their contractual agreements and to look for alternative sponsorship. "The two sports were given time to restructure their sponsorship deals so that it will not disrupt their plans. As such, the government has no plans to reverse the decision," said Razali when answering a question from Datuk Abd Rahman Dahlan (BN-Kota Belud) at the Dewan Rakyat here today.

Abdul Rahman had wanted to know if the government has any intention of withdrawing the ban on cigarette sponsorship because the standard of sports in the country had dropped drastically due to lack of funds.

Razali added that though the standard of football had dropped, it was not fair to label all other sports in the same category as a number of Malaysian athletes are ranked among the top 10 in the world.

"We have athletes who are ranked among the top 10 in 9 sports," he said. Malaysian squash queen Datuk Nicol David is the women's world number one while Datuk Lee Chong Wei is the men's singles world number one in badminton.

November 19, 2009 - Indoor smoking bans have forced smokers at bars and restaurants onto outdoor patios, but a new University of Georgia study in collaboration with the Centers for Disease Control and Prevention suggests that these outdoor smoking areas might be creating a new health hazard. The study, thought to be the first to assess levels of a nicotine byproduct known as cotinine in nonsmokers exposed to second-hand (secondhand, SHS, environmental tobacco smoke, ETS, sidestream, involuntary, passive) outdoors, found levels up to 162 percent greater than in the control group.

PAPER: Assessment of Exposure to Secondhand Smoke at Outdoor Bars and Family Restaurants in Athens, Georgia, Using Salivary Cotinine, J. C. Hall, J. T. Bernert, D. B. Hall, G. St. Helen, L. H. Kudon, and L. P. Naeher, J Occup Environ Hyg. 2009 Nov;6(11):698-704, ABSTRACT.."Indoor smoking bans have helped to create more of these outdoor environments where people are exposed to secondhand smoke," said study co-author Luke Naeher, associate professor in the UGA College of Public Health. "We know from our previous study that there are measurable airborne levels of secondhand smoke in these environments, and we know from this study that we can measure internal exposure.

"Secondhand smoke contains several known carcinogens and the current thinking is that there is no safe level of exposure," he added. "So the levels that we are seeing are a potential public health issue." Athens-Clarke County, Ga., enacted an indoor smoking ban in 2005, providing Naeher and his colleagues and ideal environment for their study. The team recruited 20 non-smoking adults and placed them in one of three environments: outside bars, outside restaurants and, for the control group, outside the UGA main library. Immediately before and after the six-hour study period, the volunteers gave a saliva sample that was tested for levels of cotinine, a byproduct of nicotine and a commonly used marker of tobacco exposure.

The team found an average increase in cotinine of 162 percent for the volunteers stationed at outdoor seating and standing areas at bars, a 102 percent increase for those outside of restaurants and a 16 percent increase for the control group near the library.

Naeher acknowledges that an exposure of six-hours is greater than what an average patron would experience but said that employees can be exposed for even longer periods. "Anyone who works in that environment —waitresses, waiters or bouncers —may be there for up to six hours or longer," Naeher said. "Across the country, a large number of people are occupationally exposed to second-hand smoke in this way."

Studies that measured health outcomes following indoor smoking bans have credited the bans with lowering rates of heart attacks and respiratory illness, but Naeher said that the health impacts of outdoor second-hand smoke are still unknown.

In Naeher's study, cotinine levels in the volunteers at the bar setting saw their levels increase from an average pre-exposure level of 0.069 ng/ml (nanograms per milliliter) to an average post-exposure level of 0.182 ng/ml. The maximum value observed, however, was 0.959 ng/ml. To put that number into context, a widely cited study has determined that an average cotinine level of 0.4 ng/ml increases lung cancer deaths by 1 for every 1,000 people and increases heart disease deaths by 1 for every 100 people.

Still, the researchers caution that it's too early to draw policy conclusions from their findings. Cotinine is a marker of exposure to tobacco, Naeher said, but is not a carcinogen. The team is currently planning a study that would measure levels of a molecule known as NNAL, which is a marker of tobacco exposure and a known carcinogen, in people exposed to second-hand smoke outdoors.

"Our study suggests that there is reason to be concerned about second-hand smoke levels outdoors," said study co-author Gideon St. Helen, who is pursuing his Ph.D. through the university's Interdisciplinary Toxicology Program, "and our findings are an incentive for us to do further studies to see what the effects of those levels are."

November 19, 2009 -Great American Smokeout.. Great American Health Challenge.. To help raise awareness about smoking cessation, the American Cancer Society has scheduled the 28th annual Great American Smokeout for Thursday, November 19, to encourage smokers to quit for a day in hopes that some will quit for a lifetime.

As stated above the tobacco regulations specify cigarettes that contain certain characterizing flavors are considered adulterated and are prohibited. "Characterizing flavor" can be defined as a distinguishable taste or aroma that is imparted to tobacco or tobacco smoke either prior to or during consumption.

Each tobacco product must be thoroughly analyzed by the FDA Product Center to determine what "Characterizing flavor(s)" are present. For example, a users experience with Camel SNUS FROST flavor: It tasted more like a candy than a tobacco product, in fact it was delicious. I would compare the taste to a vanilla-mint piece of gum. - see above.

November 18, 2009 - Lower income Massachusetts smokers have dramatically abandoned their habit amid a major state campaign that vigorously promotes and pays for tobacco addiction treatment, according to a report scheduled to be released this morning.

Smoking rates among the poor plummeted 26 percent in the first two years of the ongoing state program, a striking result that is already drawing national attention to the effort. Officials targeted a population that historically had the highest smoking rates in Massachusetts.

The study, issued by the Department of Public Health, found early indications that the tobacco cessation efforts - aimed at patients enrolled in the state’s medical insurance for the poor, MassHealth - are reaping immediate health benefits.

Once patients began receiving counseling and medications to help snuff out their habits, they made fewer trips to emergency rooms because of wheezing bouts of asthma, and there was a trend toward fewer life-threatening heart attacks.

For years, low-income smokers have been among the most persistent smokers - and the most difficult to reach with campaigns to quit. That was attributable in no small part to the cost of nicotine replacement drugs and even pricier prescription drugs that douse the brain’s insatiable craving for the addictive chemical in cigarettes. As a result, smoking rates among the poor had hovered close to 40 percent since the late 1990s - nearly 2 1/2 times the statewide rate for adults, which stands at 16.1 percent.

So the Legislature mandated that the costs of cessation should be covered by MassHealth. And they embraced the double-barreled approach championed by tobacco control specialists, which combines counseling and medication. The drugs include patches, gum, and other nicotine substitutes along with drugs designed to thwart nicotine’s addictive effects.Co-pays for drugs and counseling were all but eliminated, with patients charged no more than $3. The state spent $10.9 million on tobacco cessation for MassHealth patients from July 2006 through June 2008. (More recent figures are not available because health insurance claims are still being processed, a state spokeswoman said.)

“But it’s not enough to have a benefit," said Lois Keithly, director of the Massachusetts Tobacco Cessation and Prevention Program. “It has to be promoted." The state took to the airwaves and the road, flooding food banks and medical clinics with more than 100,000 fliers touting the campaign. The expectation, based on the experience of other states and health plans, was that 5 to 10 percent of MassHealth patients who smoked might seek help in the first couple of years, Keithly said. Instead, from July 2006 to May of this year, about 75,000 patients had used the services - two of every five MassHealth smokers.

Dr. Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital, “We wondered if this population would be interested in cessation," said “It turns out they were interested - they just couldn’t afford it."

Click to enlarge: By the summer of 2008 - the latest data available - smoking rates among adults 18 to 64 on MassHealth had for the first time descended below 30 percent.

Knowing it was possible, albeit unlikely, that other forces might be influencing the rapid decline, state tobacco control specialists compared smoking rates of MassHealth patients with another cadre of adults prone to tobacco use - those who have no insurance and no coverage for cessation.

Even as smoking rates plunged among adults on MassHealth, to 29.6 percent, they remained largely unchanged - at more than 36 percent - among patients without insurance.

Four independent tobacco control specialists asked by the Globe to review the state’s report said they found it persuasive, although they cautioned that declines in certain smoking-related health conditions need more evaluation and should not be regarded as definitive.

State researchers culled the medical records of about 13,000 MassHealth patients who received tobacco cessation drugs as part of the campaign, hunting for trends related to asthma and heart disease, two conditions inextricably linked to smoking.

The researchers found that in the year before patients started taking tobacco-control medication, 22.7 out of every 1,000 visited an emergency department because of asthma. A year later, that figure dropped to 18.7 per 1,000, a reduction that reached statistical significance.

Serious heart attacks declined, too, from 3.2 per 1,000 MassHealth patients to 2 per 1,000, a trend that, while encouraging, needs further confirmation. Although the study being released today does not assess whether the stop-smoking campaign reduced health care costs overall, the findings led some advocates to call on the state to make all health plans - public and private - provide cessation programs with low co-pays and deductibles.

“I think the numbers will show that would be worth doing,’’ said Valerie Bassett, executive director of the Massachusetts Public Health Association, which represents public health specialists. “Especially when we’re looking at cost savings, it’s one of the easiest ones to realize.’’

November 18, 2009 - Dr Twalib Ngoma, president of the African Organisation for Research and Training in Cancer (AORTIC), says that Africa is on the brink of a smoking epidemic. "Africa is in the area of the pre-epidemic and so we should prevent the epidemic. We should not wait until there is an epidemic and then work on it. We should prevent the epidemic."

One of the reports presented there warns that African nations are set to undergo the highest increase in the rate of tobacco use among developing countries. The report, released jointly by the American Cancer Society and the Global Smokefree Partnership, says that more than half of African countries will double tobacco use within 12 years if current trends continue. But the authors say that there is still time to do something about it.

Preventing the epidemic'.. "For the first time in history, we have the tools in hand to prevent a pandemic," says Dr Otis W Brawley, chief medical officer of the American Cancer Society. "Smoke-free public places are one example of a low-cost and extremely effective intervention that must be implemented now to protect health."

As well as Kenya, Niger also recently introduced a smoking ban in public places. Egyptian residents walk under hanged cardboard cigarettes during a 'No Smoking Day' in Cairo. Egypt is unlikely to introduce a smoking ban in public places

Mauritius also recently passed a law that the American Cancer Society says is close to meeting the Framework Convention on Tobacco Control (FCTC) standards, ranking the laws among the most robust anti-smoking measures in the world.

But the report says that many other countries have not taken any action. For some countries, introducing a smoking ban would face too much popular opposition.

While in Egypt a fatwa, or Islamic ruling, gives wives the right to divorce their smoking husbands if the smoke affects their health, there are no laws about smoking in public places yet. Since around half of the population indulge in cigarettes or water-pipes, such a measure would prove extremely unpopular.

'They lobby and lobby' to legislation on tobacco, it is difficult to enforce those laws. "We have legislation in Tanzania... but enforcement of that legislation is not easy. Tobacco companies are all too powerful.

It says the companies try to convince African governments that tobacco is important to economic activity and that raising taxes on cigarettes and implementing smoke-free laws will result in revenue and job-losses.

The organisation says that in Kenya, for example, the tobacco industry has issued a legal challenge to a strong smoke-free law passed by the parliament. And in Zambia, they say that British American Tobacco has helped to dilute proposals for a smoke-free law.

But British American Tobacco say that this accusation does not reflect reality. They say that while they were consulted on the draft bill in Zambia last year, the bill has never been finalised. They add that they support tobacco regulations in the countries they do business in as they recognise that tobacco consumption poses real risks to health. Their policy on public place smoking is that they support the creation of smoke-free areas but that a ban on all indoor smoking in work and public places goes too far.

Raising Prices.. If a consumer is addicted to tobacco, then it is possible to put prices up and they will go without lunch says Adam Spielman, Tobacco industry analyst for Citigroup. Spielman also blames advertisers who he says are hooking in Africa's younger generations. "Tobacco companies are targeting poor, developing countries in Africa. If you drive from the airports to most towns you will see a lot of billboards promoting tobacco, saying that if you smoke you are going to be successful."

The American Cancer Society agrees, saying that the tobacco industry in Africa tries to hold back legislation.

So just how important is the African market to tobacco companies? Spielman says that the African market forms around 10% or less of the profits of the biggest companies, but that this area is growing.Africa heading for 'smoking epidemic' by Helena Merriman, BBC News, 11/17/2009.

Kyrgyz Health Minister Marat Mambetov told the committee that "a full ban on all forms of advertising in the mass media reduces the social attractiveness of smoking and reduces the consumption of tobacco products, especially among young people."

Research done in other countries shows that "cigarette consumption dropped by on average 25% after tobacco advertisements were banned," the minister said. Appropriate changes to the law On Advertising will be made in the nearest future, the minister said.

In the meantime, tobacco advertisements are one of the main sources of revenues for the mass media in Kyrgyzstan.

November 17, 2009 - The NHS Trust (A National Health Service trust provides services on behalf of the National Health Service (NHS) in England and NHS Wales) had recruited the photographer Rankin to assist with the hard-hitting anti-smoking film, which was being used as part of a multimedia campaign launched in September. Rankin had co-directed the film with Chris Cottam, which shows a smoker suffering an assault from an invisible assailant as he walks down the street. (NHS - anti-smoking multimedia campaign starts..)

Freedom2Choose lodged a complaint against the material and upon consideration, the NHS Trust has agreed to remove it from all venues within the next two weeks.

Phil Johnson, pub and club liaison officer of Freedom2Choose states, “I am thrilled about this decision as I have had several pub and club clientele contacting me and informing me that they had been abused as result of this material.”

Freedom2Choose will actively campaign against the abuse and hatred that individuals continue to suffer as a result of modern anti-smoking techniques.

Click to enlarge: November 17, 2009 - A ban on smoking in bars and pubs has prompted many New Zealanders to stop smoking at home, Ministry of Health research shows.

Next month will mark six years since the passing of smoke-free legislation that bans smoking in indoor work environments such as clubs, casinos, bars and restaurants. The ban became in force in December 2004 and New Zealand became the third country in the world after Ireland and Norway to ban smoking in pubs and restaurants. The legislation extends a 1990 ban on smoking in offices, shops and public buildings to pubs, clubs, restaurants, casinos and school grounds. (New Zealand introduces new smoking ban; rte.ie/news, 12/10/2004) A ministry expert on tobacco, Dr Ashley Bloomfield, says one of the positive spin-offs of the law has been that the number of smoke-free homes has dramatically increased. He attributes the trend to a change in attitude – "People started thinking, `I can't smoke in the pub so I won't smoke in my home'."

Bloomfield says the law's main objective – to reduce workers' exposure to second-hand smoke – has been achieved.

A report evaluating the law's effectiveness and impact across various sectors shows exposure to second-hand smoke in the home decreased from 20% in 2003 to 9% in 2006. And the cultural shift, which has seen smoking become less socially acceptable, has seen smoking rates fall year on year.

Ministry of Health research shows there was an initial spike in supermarket liquor sales after the change in smoking laws, and a moderate drop in retail sales for bars and pubs, but this was not sustained.

"We already had a ban on smoking in office spaces so we were extending that to blue collar facilities like bars and restaurants. There was a bit of difference between Maori and non-Maori exposure in the workplace. We got rid of these quite stark inequalities."

The 2006 figures showed the number of workers exposed to smoke fell to 8% from 20%. Importantly, the numbers of non-smoking young people continues to rise, with half of teens aged 15-19 years now saying they have never even tried a puff of a cigarette compared to 39% in 2006.

Bloomfield said: "The social environment and the social context has changed... "When this legislation was passed there was 50% public support for extending the smoke-free ban into the bars. Support went from under 50% to 82% within two years. Even two-thirds of smokers supported that full ban. The interesting thing is how quickly the public appreciate [being] smoke-free."

November 17, 2009 - One in two cigarettes smoked in Ontario is illegal (illicit, smuggling, black market), robbing provincial and federal coffers of more than $2 billion a year and raising concerns about children gaining easy access to tobacco. A study for the Canadian Tobacco Manufacturers' Council found that illegal cigarette purchases in Ontario have climbed to 48.6 per cent, followed by Quebec with 40.1 per cent. Canada-MAP..

Ontario and Quebec represent about 95 per cent of illegal tobacco sales in Canada, and about 33 per cent of cigarettes sold in Canada are contraband, according to the manufacturers' council study.Government officials and anti-smoking activists are alarmed because the cheap and easily available cigarettes will enable more children and teens to pick up the habit.

The Canadian Cancer Society is watching the situation closely. Rob Cunningham, a senior policy analyst at the Canadian Cancer Society, said widespread access to cheap cigarettes is undermining the effectiveness of tobacco control legislation and programs. "Higher prices are the most effective means of discouraging smoking, especially among teenagers, who are more price sensitive than adults," said Cunningham. "We would be seeing smoking rates go down much faster if we could get contraband under control."

Health advocates warn the historic decline in the number of smokers is starting to slow due to the availability of cheap cigarettes. Last year, about 18 per cent of Canadians aged 15 years and older were smokers. The previous three years it was 19 per cent.

Cunningham: "Ontario and Quebec have the lowest tobacco taxes in Canada, but the highest rates of contraband. (Federal tobacco taxes have not increased since 2002 and the main reason is contraband concern.) So contraband is not caused by taxes, it is caused by the proximity to the sources of supply." The major source of that supply is the Akwesasne native reserve that straddles Ontario, Quebec and the State of New York. Ten cigarette manufacturing plants on the U.S. side pump out billions of cigarettes annually.

"We know that perhaps 95 per cent of the contraband in Canada originates in illegal operations located on four First Nations reserves, the most important of which by far is the U.S. side of Akwesasne near Cornwall, Ont. There is also Kahnawake near Montreal, Tyendinaga near Belleville, and Six Nations near Brantford," said Cunningham.

Because of the international border issues and sensitivities surrounding First Nations, the Ontario government concedes that fighting contraband tobacco is "huge" and "complex."

Federal Public Safety Minister Peter Van Loan, whose government has been criticized for inaction, insists Ottawa is taking the matter seriously. "Obviously, contraband tobacco is a major concern," said Van Loan, noting it is worrying for reasons beyond just public health. "This is related to organized crime in a significant way," he said, touting the Conservative government's anti-contraband strategy, which includes beefed-up policing. "It's interesting to note that this year I think seizures are up dramatically, both in dollar terms and in quantities, so that plan is working," said Van Loan.

Some of the money earned from the sale of black market smokes is fueling firearm and drug smuggling efforts by organized criminal groups assists Gary Grant, a former Toronto cop, who heads of the National Coalition Against Contraband Tobacco.

The RCMP (Royal Canadian Mounted Police), assisted by the Ontario Provincial Police, is trying to stamp out the illegal cigarette trade. But the Mounties complain that while they are doing their best to round up the smugglers, the courts go far too easy on them. RCMP Sgt. Michael Harvey said fines of $50,000 to $100,000 are assessed, but the courts allow them to pay $10 to $50 a month. And, even then, the scofflaws don't bother.

The Canadian Coalition for Action on Tobacco has recommended ways Ottawa can tackle the problem: * Work with the U.S. to shut down the illegal, unlicensed factories on the American side of Akwesasne. * Prohibit the supply of raw materials including raw leaf tobacco, cigarette packaging, filters and rolling paper, to anyone without a valid tobacco manufacturer's licence. * Promote with First Nations the benefits of having a native tobacco tax equal to the provincial one. * Increase penalties substantially to deter would-be smugglers and manufacturers.

November 17, 2009 - The world’s seventh largest producer of tobacco, Malawi earned just $162m (£97m) from this cash crop in 2007. The tiny nation is the supplier of 10% of all Burley tobacco, the premium leaf used in most of Britain’s leading cigarette brands.

We have reported tobacco pickers in Malawi are exposed to "extremely high levels of nicotine poisoning." Little government attention is devoted to the environmental damage caused by tobacco. Because nicotine is regarded as harmful to both humans and the environment, the US Environmental Protection Agency has designated waste tobacco as toxic. Such waste is classified as “toxic and hazardous” by European Union regulations when its nicotine content exceeds 0.05%.Downstream from the tobacco processing plants that dominate the outskirts of Lilongwe, the Malawian capital, rivers run yellow and green from industrial outflow. Even more alarming, however, is that in a community already plagued by Aids, cholera, malnutrition and one of the highest infant mortality rates in the world, toxic tobacco waste is being dumped by contractors in open landfill sites where hundreds of children are picking through the remnants. The children try to sell the waste for fertiliser or for use in cheap black-market cigarettes bound for Zimbabwe. But they pay a heavy price by risking their health.

The report claimed that children forced to work as tobacco pickers are exposed to nicotine levels equivalent to smoking 50 cigarettes a day. Child labourers as young as five, it alleged, are suffering severe health problems from a daily absorption of up to 54 milligrams of nicotine through their skin.

Those interviewed for its report spoke of common symptoms of so-called green tobacco sickness, or nicotine poisoning, including severe headaches, abdominal pain, muscle weakness, coughing and breathlessness.